2068 Hwy 64E �, _:
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�,� �""�'�_ . . --��^' ""r . DAVIE COUNTY HEALTH DEPARTMENT '�'"���-
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--�� = ' - r IMPROVEMENTS PERMIT AND CERTIFICATE OF COMPLETION
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.'`w�N ; . .Sanitary Sew ge Systems .-';,;-, � ,.; ��,,Chap/er 130a � Pe�mi
, OT�:Issued in Com liance With Article II of G S
� t Number
` J .�,�,�,:s .�''�/� � ::�:' .,�`io. _ ,i%y�,i �Date �!��`iji N� 7 7 9 U
• Name - �
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Location �- ;�� -r�. ,,_ ;i J;._;,�, /,r ,% ,,.�-..r' _ _
. — : — --�— 4'�l�s �w�� ��
Subdivision Name Lot Na Sec. or Block Na
Lot Siie r.r-��— _ House _ s� Mobile Home ____ Business __ Industry
�,J
No. Bedrooms � �—_.No. Baths �-`�__ No. in Family' ' � _ PublicAssembly Other _
Garbage Disposal YES NO p Specii�cations tor System:
Auto Dish Washer YES NO p /, .�,,, , �- ,r ,�'' �-'
r t fC L%�:�`"�'� r L�_.� .a., G�
Auto Wash Ma^hine YES NO ❑ -
�' ��/�}���S'���'�jA
Type Water Supply _� l ____ _
'This permit Void ii sewage system described below is not installed withm 5 years from date of issue.
. This permit is subject to revocation if site plans or the intended use change
;ATTENTION: ' ., YOUR SEPTIC SYSTEM CONTRACTOR MUST SEE THIS PERMIT�LAYOUT BEFORE INSTALLING THIS
SYSTEM.
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� Improvemenls permit by ����!_.,1�%�—
•Contact a representative oi the Davie Counry Health Department for final inspection of this system between 8:30-9:30 A.M.,
1:00-1:30 P.M.or 4:30-5:00 P.M.on day of completion.Telephone Number: 704-634-5985.
Final Installation Diagram: System Installed b �a —�A� �
y�^" ,
.pAM' $ � DR''�� ' � ' i �p� '
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Certiiicate of Completion u� __ Date �0 '�� ` + � _
'The signing of this certificate shall indicate that the system describe above has been installed in compliance with
the standards set iorth in the above�regulation, but shall in NO way be taken as a guarantee that the system will function
satisfactorily tor any given period of time.
; �
�
,_ APPLICATION FOR SITE EVALUATION/IMPROVEMENTS PE I�T � �Cj � Q �
� Davie County Health Department �
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� Environmental Health Section �R 2 4 �,�•J
P. O. Box 665
� Mocksville, NC 27028
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1. Application/Permit Requested By ' �'�
, Mailing Address Home Phone 9 7 I "T� � �,
p ��^ Business Phone ��d^ ��
2. Name on Permit if Different than Above �- �''���;s�,��,�d.y-� ��1�- ��
3. Application for: ❑General Evaluation �7Septic Tank Installation Permit
4. System to Serve: �ouse � Mobile Home � Place of Public Assembly
❑ Business ❑ Industry ❑ Other ❑ Unknown
5. If house, mobile home: Subdivision Section Lot #
p Basement/Plumbing
No.of People � ' �asemenUNo Plumbing
No. of Bedrooms ;� B'Gaashing Machine
No. of Bathrooms � �shwasher
Dwelling Dimensions �U n S�� G�Garbage Disposal
6. If business, industry, place of public assembly, other: Specify rype
No. of People Served No. of Sinks
No. of Commodes No. of Urinals
No. of Lavatories No. of Water Coolers
No. of Showers Water Usage Figures
7. Type of water supply: l� Public ❑ Private � Community
8. Property Dimensions � a-C��A Sewage Disposal Contractor
9. Do you anticipate additions/expansion of the facility this sytem is intended to senre? ❑ Yes ��
If yes, what type?
'NOTE: Improvements Permits shall be valid for a period of 5 years from date issued. Improvements Permits are subJect to
revocation, if site plans or the intended use change. Effective October 1, 1989. .
Directions to Property: �
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PP �
��S � �I�.SS 1N�ers Gc.�i�a1✓ d � �rt'V A-�-2e�" �-c�
�,�d. (��4 d r., j�..; �a-
s
This is to certity that the information provided is correct to the best of my knowledge, and I understand I am responsible for all charges
incurred from this application.
�-r-�-�t-��. � `
DATE SIGNATURE
CONSENT,F�R SITE EVALUATION TO BE D NE ON ABOVE DESCRIBED PROPERTY
MUST CHECK ONE: O 1. I OWN the property. � 2. I DO NOT OWN the property.
If you checked Box #2, the rest of this form MUST be completed by the owner or a person authorized by the owner:
I hereby give consent to the authorized representaty'�e of the Davig Cou ty alth D�qartr�ent to enter upon above described
property located in Davie County and owned by �J�I��S C�.S��Ht�- H-)i�l
to conduct all testing procedures as necessary to determine sai site's suitability for a ground absorption sewage treatment
and disposai system. ,
�!���1-9� � ,
DATE IGNATURE
DCHD�(1/93)
�
. � '� , �
< DAVIE COUNTY HEALTH DEPARTMENT
�• , Environmental Health Section
: ` Soil/Site Evaluation
/f T i
NAME �iSYL( DATE EVALUATED J QS"
ADDRESS PROPERTY SIZE ��/'¢e
PROPOSED FACIILTY J� ri�J�ll-�� LOCATION OF SITE r�'��,L-J
Water Supply: On-Site Well _ Community Public 1�
Evaluation By: AugerBoring � Pit Cut
FACTORS 1 2 3 4
Landsca e osition .L �--
Slo e �
HORIZON I DEPTH
Texture rou
Consistence '
Structure
Mineralo
HORIZON II DEPTH �' �` "
Texture rou
Consistence
Structure ,� /�
Mineralo ' �
HORIZON III DEPTH
Texture rou
Consistence
Structure
Mineralo
HORIZON IV DEPTH
Texture rou
Consistence
Structure
Mineralo
SOIL WETNESS
RESTRICTIVE HORIZON
SAPROLITE
CLASS.LFICATION
LONG-TERM ACCEPTANCE RATE �
SITE CLASSIFICATION: �� EYALUATED BY: �
LDNG-TERM ACCEPTANCE RATE: � � OTHER(S) PRESENT:
REMARKS:
LEGEND
Landscape Position '
R-Ridge S•-Shoulder L-Linear slope ` ' FS-Foot slope N-Nose slope
CC-Concave slope CV-Convex slope T-Terrace FP-Flood plain H-Head slope
Texture
S-Sand LS-Loamy sand SL-Sandy loam L-Loam SI-Silt
SICL-Silty -:lay loam• SIL-Silty loam CL-Clay loam SCL-Sandy clay loam
SC-Sandy clay SIC-Silty clay C-Clay ;
CONSISTENCE
Moist ;
VFR-Vc.-y friable FR-Friable FI-Firm I VFI-Very firm EFI-Extremely firm
Wet
NS-Non sticky SS-Slightly sticky S-Sticky VS-Very Sticky
NP-Non plastic SP-Slightly plastic P-Plastic VP-Very plastic
Structure
.iC--Sinfile grain M-Massive CR-Crumb GR-Granular ABK-M�ular blocky
SBK-Subangular blocky PL-Platy PR-Prismatic
Mi neralagy
1:1, 2:1, Mixed .
Notes
Horizon depth - In inches
Depth of fill - In inches
Restrictive horizon - Thickness and inches from land surface
Sapcolite - S(suitable), U(unsuitable)
Soil wetness - Inches from land surface to free wate�' or inches from land surface to soil colors
with chroma 2 or less
Classification - S(suitable), PS(provisionally suitable), U(unsuitable)
LTAR - Long-term acceptance rate - gal/day/ftz
DCHD(01-901
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-- —. DAVIE COUNTY HEALTH DEPARTMENT � ` '� '
, _ �
� - ' (Septic Tank) Lnprovements Permit and Certificate of Completion
, , (Ground Absorption Sewage Disposal System - G.S. Chapter 130-Article 13C)
OWNER OR CONTRACTOR 1.. r�x.,,'_, ?-,;�� DATE �' ��'�!- PERMIT
l .. , _.
LOCATION �t��a� . ;��k� r- , ,.� L..�_ ,..,,,..,. 1��_� � I-�r -, N�
1021
. � 1 � S.R. N0.
SUBDIVISION NAME LOT N0. SECTION OR BLOCK N0.
HOUSE MOBILE HOME $USINESS ❑
House Trailer 800 Gal. 400 Sq. Ft.
N0. BEDROOMS �� N0. B�ATHROOMS �. Two Bedroom House 800 Gal. 600 Sq. Ft.
GARBAGE DISPOSAL UNIT YES ❑ NO ❑ Three Bedroom House 900 Gal. 900 Sq. Ft.
� AUTO. DISHWASHER YES �' N0 ❑ Four Bedroom House 1000 Gal. 1200 Sq. Ft.
AUTO. WASH. MACHINE YES �� NO ❑
SITE SUITABLE YES 0" NO ❑
SIZE OF TANK (S'� gal.
NITRIFICATION FIELD sq. ft. ,
DEPTH OF STONE IN LINES: �. ����t,�•�t.Q,�iv�. �
WATER SUPPLY: Individual � Public ❑
IMPROVEMENTS PERMIT BY r`',°��? �"�"'��t?�,��t= INSTALLED BY p,r „ L u�
CERTIFICATE OF COMPLETI03�i �By `= �` Date 4'�(r���
�
(8/16/73) *Construction must co ply with all other applicable State and local regulations
LOT AREA c� 1�C' '`� , ' . � , "
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Parcel#: J60000007404 Page 1 of 1
o�'�t�
Davie County, NC - Basic Estate Search �oU�,�.�
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View Pro�ertv Record for this Parcel Vfew Maa for this Parcel View Tax Bill Information
Parcel#:J60000007404 Account#:31716000
Owner Information Tax Codes
HALL LEWIS ALLEN&HALL SANDRA BOGER ADVLTAX-COUNTY T
068 US HIGHWAY 64 EAST FIREADVLTAX-FIRE TAX
MOCKSVILLE NC 27028
Pro e Information Townshi
nd(Units/Type): 3.200 AC FULTON
ddress: 2068 E US HWY 64
Deed Information Local 2onin
Date: 01/1900 Book: Page:
Plat Book: Pa e:
Le al Descri tion PIN
3.203 AC HWY 64 5757785899
Pro e Vatues
uildin : 250 73
BXF• 7 90
nd• 37 62
Market: 296 25
essed• 296 25
eferred•
Sales Information
No Sales Data found.
View Prooertv Record for this parcel y�gw Mao for this Parcel�/iew Tax Bill Infortnation
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All information on this site is prepared for the inventory of real property found within Davie County. All data is compiled from recorded deeds,
plats, and other public records and data. Users of this data are hereby notified that the aforementioned public information sources should be
consulted for verification of the information. All information contained herein was created for the Davie County's internal use. Davie County,
its employees and agents make no warranty as to the correctness or accuracy of the(nformation set forth on thfs site whether express or
implied, in fact or in law, including without 1lmitation the implied warranties of inerchantability and fitness for a particular use.
If you have any questions about the data displayed o�thls website please contact the Davie County Tax Office at(336) 753-6120.
1.5.9
http://maps.daviecountync.gov/itsnet/View.aspx?prid=1460818 6/28/2016